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Technical note
Fig. 1. Placement of the first (1) and second needles (2) in the conventional
approach for arthrocentesis of the temporomandibular joint. In the technique
that we have described, the second needle (3) is 3 mm posterior to the first
needle (1), which was inserted 10 mm anterior and 2 mm inferior along the
canthal-tragal line.
0266-4356/$ see front matter 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2009.06.020
A. Alkan, O.A. Etz / British Journal of Oral and Maxillofacial Surgery 48 (2010) 310311
311
(Fig. 2). Laskin mentioned that insertion of the second needle anterior to the first one is usually difficult, and he has
inserted the anterior needle in the posterior recess of the
upper joint compartment by placing it 34 mm anterior to
the first one.5 However, if the second needle is anterior
to the first one it is inserted into a narrower region of the
upper joint compartment (Fig. 3), and this may cause damage to the disc and unexpected failure of outflow. Outflow
is easier to achieve when the second needle is inserted posterior to the first one in the wider part of the upper joint
compartment.
The use of this landmark as the default technique may be
reasonable, as repeated insertions of a needle are uncomfortable both for physicians and patients and adversely affect the
success of the treatment.
References
Fig. 3. The second needle anterior to the first one would be in the narrower
part of the posterior upper joint compartment (black arrow) and closer to
the articular disk (D). (Reprinted from: Nanci A. Ten Cates oral histology:
development, structure and function. Chicago: Mosby, 2003; reproduced by
permission of the publisher.)
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2. Guarda-Nardini L, Manfredini D, Ferronato G. Arthrocentesis of the
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